Pregnancy: issues of infertility

Pregnancy is not just about your baby=it can also be a turning point in your own life Parents to be start to realize they can no longer get away with skipping meals, pushing the body until it collapsed in exhaustion, not really thinking about the food they eat. By ensuring that both parents are fir and healthy before and during pregnancy, you will not only be giving your baby the best possible start in life, but also be giving yourselves an early helping hand in dealing with a newborn baby. The aim of this chapter is to help you to prepare for a healthy pregnancy, to enjoy the experience of carrying a baby, and to lay the groundwork to feel well after the birth.

One important point I would like to make is that food is best assimilated in a relaxed body. Becoming obsessive about every morsel of food you put into your mouth will not help you or your baby. While food safety guidelines are designed to reassure expectant parents that they are doing the right thing food should always be seen as something movable.

 Pre-conceptual care

If you are hoping to have a baby, you should begin preparing for the pregnancy at least three months before you start trying to conceive. This allows your body to stock up on vital vitamins and minerals: such as folic acid, and also to cleanse itself of less desirable substances, such as prescription drugs or nicotine from cigarette smoking for more information on diet and its relation to fertility

If your pregnancy was it planned and there his been no time for pre conceptual care, don’t worry. If you begin taking extra care of your health as soon as you know you are pregnant, your baby will still get the best start in life. If you are taking hormonal contraceptives such as the pill, you should change to a barrier method, such as the condom, for at least three months. This allows your body time to re establishing its own cycle and hormonal balance. An unborn baby exposed to rubella (German measles during the early months of develop mint can be born severely handicapped.

If you are not sure whether you are immunized in rubella, consult your doctor who may recommend that you are immunized and then wait a month before you try to get pregnant.

• Give up smoking creates a greater risk of miscarrying and developing problems during the pregnancy. There is also a risk of sudden infant death syndrome (SDS) among babies whose parents or careers are smokers . If possible avoid taking medication before conception and during pregnancy Check with your doctor about the safety of any prescription medications For both men and women, the key nutritional issues that directly affect your ability to conceive and enjoy a healthy pregnancy are body weight, vitamin and mineral intakes and alcohol.

BODY WEIGHT

Before trying to conceive, it is helpful to bring your weight into the ideal range. If you are overweight, a healthy weight loss plan will enable you to lose weight without sacrificing crucial vitamins, minerals and other nutrients Avoid crash diets, which can upset your hormonal balance and inhibit conception Certain complications, such as high blood pressure and pregnancy onset diabetes, are more common if you are overweight before you get pregnant. However,

if you are overweight, don’t panic Just be aware that you need to be careful not to put on excess weight during pregnancy Being underweight can also affect fertility and the progress of the pregnancy If you are naturally slight but are healthy and eat well, you have no need to worry. However, if you have been dieting and have a body mass index below 20. think about nourishing yourself a little more and putting on a few pounds. This will not only help you become pregnant, but will also allow you to have a more positive pregnancy experience and leave you stronger after giving birth. Remember that excess weight can come off after the birth – it is more important that your body receives the nutrients you and the baby need,

VITAMINS AND MINERALS

A varied, balanced diet see the chapter on Understanding your nutritional needs.). including fresh unprocessed foods, preferably organic, should contain adequate vitamins and minerals. Certain of these nutrients are particularly relevant.

FOLIC ACID

A diet rich in folic acid has been shown to decrease the chances of giving birth to a baby with neural tube defects, such as spine bifida. It is therefore advisable to boost your intake of folic acid at least three months prior to conception and continue to do so for at least the first three months of pregnancy.

Foods rich in folic acid include: green leafy vegetables such as spinach, broccoli, Savoy cabbage curly kale, Brussels sprouts and asparagus: citrus fruits such as oranges and grapefruits, pulses such as black-eyed beans and chickpeas, dairy products, yeast extract (spread it on bread or dissolve it in hot water and use in cooking cereals and breads fortified with folic acid.

The folic acid content of foods decreases with time, so the amount in freshly picked asparagus is far higher than in asparagus that has been in transit for several days. Folic acid is also lost through heating, so a spinach salad or broccoli stir fry is better for you than the boiled vegetable In addition to cantina folic acid rich foods,

the Department of Health in the UK recommends that women planning a pregnancy also take a supplement of 400 micrograms of folic acid for three months before conception and throughout the first three months of pregnancy. This adds an extra safety net. Certain drugs may decrease the amount of folic acid you store within your body. These include some indigestion remedies (antacids) and antihistamines Alcohol also interferes with the storage of folic acid Since folic acid is absorbed in the small intestine, any disease that affects the fining of the small intestine, such as Crohn’s disease, coeliac disease or ulcerative colitis, can cause a folic acid deficiency. If you suffer from any of these conditions. discuss the issue of folic acid with your doctor or dietitian, since any change in diet may trigger some symptoms.

IRON

For both men and women, iron deficiency anemia can adversely affect fertility in women it is often related to a diet lacking in red meat in men it is most likely to arise either due to a digestive complaint such as Crohn’s disease or ulcerative colitis, or if you are taking strong medication such as anti-inflammatory drugs  on Anemia for advice on how to improve your iron intake.

ZINC AND MANGANESE

Deficiencies in these two minerals can lead to sexual problems for both men and women Low zinc and manganese levels are related to decreased libido, sterility and birth defects. Zinc deficiency is particularly common in women who have been taking the contraceptive pill, so if you have just come off the pill, I suggest you try to include plenty of zinc in your daily healthy eating plan. Foods rich in zinc Try not to rely on a supplement as excess zinc can expose you to an increased risk of bacterial infections. Manganese will be found in adequate quantities in a balanced and healthy eating plan.

ALCOHOL

Excess alcohol intake in both men and women adversely affects the ability to conceive. A small amount of alcohol may be relaxing, but in excess it can lead to decreased sensitivity in both men and women, reduced fertility in women and in men penile shrinkage and testicular atrophy that can lead to impotence In addition, excessive drinking can lower the levels of folic acid in the blood. Try to keep your alcohol intake down to no more than one unit a day. Men should stick to a maximum of 28 units a week. A unit means a glass of wine, half a pint of beer or a single measure of spirits:

What to do when you are pregnant

The first thing to do is to evaluate your diet and see whether improvements are needed. Keeping a food diary is a good start Many women make the mistake of over-nourishing You may think that because you are supporting two people your requirements double, but a baby is very small Your body does have an increased demand for vitamins and minerals. both to maintain your health and to build a strong,

healthy baby but during pregnancy your body becomes more efficient, absorbing more of the nutrients and using more of the calories you take in. You may initially think that you need to take a vitamin and mineral supplement but other than folic acid there is no need, and indeed some supplements could be harmful to your baby. The developing baby’s nutritional needs can easily be met as long as the mother follows a healthy, well balanced diet It needs to be

• rich in high fiber carbohydrates, because these foods contain energy, vitamins low in fats and refined sugars. Try to avoid eating sugary, buttery or chocolaty minerals and fiber snacks and fizzy drinks, and keep junk foods down to a minimum. moderate in lean proteins. Meat, fish, eggs, nuts, beans and lentils supply protein as well as vitamins and minerals.

Milk and dairy products such as yoghurt and cheese also provide calcium. Note that in families with a high incidence of allergies including eczema and hay fever, there is a risk of passing a nut allergy to your unborn child if you eat nuts during pregnancy. Pregnant women are advised not to use peanut oil-based creams for the same reason If you are concerned about allergies discuss the issue with your doctor. • rich in fresh fruits and vegetables (at least five servings a day). because these contain vitamins, minerals and fiber.

Remember that everything the mother eats is passed, to a greater or lesser extent to the baby. By keeping your diet as varied as possible, you will not only be benefiting your health, but also influencing your baby’s taste preferences: if the mother’s diet exposes the baby to many different flavors, he or she is more likely to be an adventurous eater. Try to stick to as many unprocessed, natural foods as possible, as the fewer additives you take in the healthier you and your baby will be If you have been used to existing on readymade meals, try to make a fresh start now.

The effects that many chemicals in common use in the food industry may have on your developing baby are as yet unknown. Organic products are best because they have not been chemically treated Alcohol can be dangerous to the developing fetus. As soon as you know you are pregnant try to either cut out alcohol altogether, or to limit your intake very strictly to a unit a day. Fetal alcohol syndrome can be caused by drinking more than 10 to 12 units a week. Alcohol also lessens the amount of folic acid in your body.

ENERGY AND CALORIES

Although you don’t need to eat for two you do need to eat enough not only to ensure that your baby grows, but also to make sure that you remain strong during the pregnancy and after the birth. It Is estimated that the total energy required during the nine months of pregnancy is in the region of 80,000 calories (kcals,) compared with the usual figure of around 55-60,000 calories needed by a non-pregnant woman over the same period.

If you met this need by simply increasing your intake, you would need to take in an extra 150 calories a day in the first trimester and 350 calories during the second and third trimesters. However, since many women expend less energy when they’re pregnant especially in the late stages, this is not really necessary I generally say that you should follow your appetite, and eat what you fancy Many women worry that they won’t be able to lose the weight they put on while pregnant,

even after birth I can assure you that this is not the case you will be able to get rid of the unwanted weight after you have stopped breast feeding if you follow a healthy weight-reducing diet, as recommended in the  Achieving your ideal weight If you stick to a healthy eating pattern of three small meals a day, with fruit snacks in between to maintain your blood sugar and energy levels, you should not put on too much weight while you are pregnant.

IRON

You need to make sure that you take in enough iron in order to help create new tissues and prevent iron deficiency anemia Every woman should maintain a good iron Intake by eating a portion of a rich, well-absorbed source of iron once a day. Lean red meat is the best source of iron, but there are alternatives These include eggs (as long as they are well cooked), baked beans, green leafy vegetables such as spinach, broccoli and sorrel. Although liver is very high in iron, it is not recommended during pregnancy because it is high in vitamin A, which is toxic in excess amounts and can harm your baby. Pâté and other liver products are best avoided while you are pregnant.

You should also not take any vitamin or mineral supplements which contain the retinol form of vitamin A The iron in non-meat foods not as easily absorbed by the body, so you need to eat more of them to gain the equivalent amount of iron. In addition, caffeinated drinks, such as tea, coffee, hot chocolate and cola inhibit the absorption of iron, so cut your intake down to no more than two of these drinks a day. Better still, cut them out of your diet completely to give your baby a good start in life Even if you eat a diet rich in iron, you may develop iron deficiency anemia in the last few weeks of pregnancy. Let your doctor or midwife know if you are feeling acutely tired or a bit depressed. They can carry out a blood test and if necessary, arrange for you to take an appropriate supplement.

VITAMIN C

This vitamin is needed for the growth of healthy body issues and also to help your body absorb iron and other important nutrients Good food sources include fresh citrus fruits such as oranges, lemons, grapefruits tangerines: kiwi fruits rosehips: tomatoes: green leafy vegetables.

CALCIUM

This is needed for the development of healthy bones, and is very important for pregnant women. You should ideally have 600 ml/1 pint of milk or its equivalent of cheese or yoghurt every day Don’t forget that you can mix your calcium sources and use them in cooking. Women who are intolerant of dairy products should boost non-dairy sources of calcium, such as green leafy vegetables, and discuss calcium supplements with their doctor or dietitian,

Food poisoning

When you are pregnant, food poisoning can be serious. It is important to follow basic food hygiene rules Wash your hands carefully after you have touched any animal. Wash all vegetables and fruits thoroughly before you eat them. Keep cooked and raw foods separately in the refrigerator. Use separate chopping boards for cooked and raw meat, fish and vegetables/fruits, Certain foods should be avoided during pregnancy

· Salt cheeses, such as cream cheese and Brie, and blue cheeses such as Stilton, carry the risk of listeria, a food poisoning illness caused by a bacterium called Listeria. It produces flu-like symptoms and in pregnant women may cause miscarriage. There are so many wonderful hard cheeses. both pasteurized and unpasteurized, that you should certainly not feel deprived of cheese for these nine months.

• Soft whip ice cream carries the risk of listeria infection. Fruit sorbets are a safer option

• Prepared salads such as shop-bought potato salad and coleslaw are other sources of listeria bacteria. Make your own salads, washing all vegetables well

• Pâtés arid ready-made chilled meals may carry listeria bacteria. You may have to forgo pate, because it is also advisable to avoid liver when you are pregnant

• Undercooked eggs can be a source of salmonella, a particularly virologist strain of food poisoning bacteria. It causes diarrhea and vomiting, as well as head ache and fever, between 24 and 48 hours after eating infected food. Any egg dishes should be thoroughly cooked. Avoid homemade mayonnaise, which is prepared from raw eggs (commercially bottled mayonnaise is safer).

. Undercooked meats and poultry, and unpasteurized milk, are other sources of salmonella,

• Raw meats or fish: it is best to steer clear of any uncooked meat, such as steak tartare and some salami, fish (such as sushi), or seafood (such as raw oysters) All meats, fish and poultry should be thoroughly cooked.

Dealing with common pregnancy problems

NAUSEA AND MORNING SICKNESS

Morning sickness is a footing of nausea and, in some cases, vomiting, which often Occurs in the morning, but can happen at any time of the day. It is caused by hormonal and metabolic changes and usually lasts no longer than the thirteenth or fourteenth week. However, some women can spend a whole nine months feeling and being sick. If you go for more than a day without being able to keep anything down consults your doctor or dietitian. To lessen the feelings of morning sickness, try the following:

• Check your iron supplement Sometimes stopping these also stops the nausea. Ask your doctor on midwife first Obviously if you do this you should make doubly sure that you are eating plenty of iron rich foods

• Don’t go for long periods without eating, even if it’s just a biscuit, oatcake or crisp bread. An empty stomach can make nausea worse, so even if it’s just a little something, it can help.

• Make sure that you are not drinking too much tea or coffee Caffeine and tannins (found in tea) aggravate nausea and vomiting

• Try soothing drinks. One of the best cures for nausea is rice water. Just take small sips of the warm water in which you have boiled rice. Peppermint ginger and chamomile herb teas are also very soothing Some fizzy drinks, such as ginger ale is also good at relieving nausea – but do sip them slowly.

• Avoid fatty foods. These are particularly difficult to digest and can irritate the muscle that normally keeps food in the stomach Starchy foods such as bread pasta, rice and potatoes are far Gentler on the system.

• Delegate the cooking if possible. If food odors get to you, and you have someone to cook for you, let them do the cooking and stay away from the kitchen. . Try to get a little fresh air before eating. If you can fit in the time, or juggle your schedule. It is often beneficial to go for a stroll to get a breath of fresh air

• Experiment with the temperature of your foods. Sometimes cold foods are more appealing when you’re feeling sick. Try a little of your favorite hard cheese, or ham and melon. Or slice a tomato on warmed ciabatta bread and garnish with fresh basil.

• Have a stock of biscuits by your bed, so you can nibble something before you ger up in the morning. Ginger biscuits would be a good idea as some people find that ginger helps reduce nausea. Resist chocolate buttery or creamy biscuits as these often aggravate nausea.

WEIGHT GAIN

Excess weight during pregnancy can increase your risk of developing high blood pressure, leading to preeclampsia, and pregnancy onset diabetes It is not just the total amount of weight you put on during the pregnancy that concerns midwives and obstetricians but also the pattern of weight gain. It is best to gain weight steadily throughout the whole pregnancy, rather than putting it on in spurts, but every woman is different and some do have fits and starts of weight gain.

The best way to ensure your weight gain pattern is a healthy one is to keep in touch with your midwife or obstetrician If you are gaining weight too fast. take steps to cut out empty calories and concentrate on getting the nutrients you really need from a healthy diet:

• Try to drink water rather than sugary drinks

• Make sure that you’re drinking at least two liters four pints of water a day

• Try not to use additional sugar in drinks and cooking

• Stick to lean proteins rather than fatty savory dishes

• Keep the amount of fat you use in cooking down to a minimum

• Aim to have at least five portions of fresh fruits or vegetables every day

• If you have a sugar craving, choose fresh, poached or dried fruits, on their own or with a spoonful of natural yoghurt or from age frays

• Choose high-fiber (wholegrain, whole meal) breads, rather than the white varieties, and include some starch such as pasta, rice or potatoes with each of your main meals. Remember to eat slowly, concentrate on what you’re eating and juggle tastes, textures and temperatures within your meals

• Ask yourself the questions ‘Do you like it and do you need it?’ If you do, then go ahead and savor every mouthful. If you don’t. don’t eat it.

INSUFFICIENT WEIGHT

GAIN Because of nausea or indigestion, some pregnant women find it hard to eat enough to put on sufficient weight. If you are concerned, here are some ideas to boost your food intake .

Try to make sure that your meals are as full of energy as possible. Don’t worry about the size of the portions, and concentrate on making sure that you are eating a variety of protein, carbohydrates and fat containing foods rather than filling up with vegetables

• Keep concentrated sources of nutrients in your diet, such as cheese, meat. milk, full-fat yoghurt. fish, butter and cream • Dried fruits such as apricots, figs and prunes are good sources of nutrients and are also high in fructose, so keep a bowl around to nibble at.

. Don’t serve one main large meal – have little meals often Serve beautifully presented little dishes that stimulate your eyes, nose and taste buds.

• Buy a selection of bread rolls, perhaps flavored with fresh herbs, olives, oils and spices, and store them in the freezer. They are quick to warm through so you will have a good source of food on tap. ready to accompany meals or as a snack If you find you still can’t gain weight after a few weeks of trying these tips, seek the advice of your doctor or dietitian.

INDIGESTION

This frequently occurs once the baby grows to the size at which its body starts pressing on your stomach. The hormone changes during pregnancy can also cause the muscles at the top of your stomach to over relax which makes it more likely that the acidic contents of your stomach will leak into your esophagus (the feeding tube leading up to your throat). The presence of acidic Juices in your esophagus causes ‘heart burn and an acidic, unpleasant sensation. It is often worse at night when you are lying down Here are a few simple tips.

Try not to eat too late at night

Try propping your head up a little while you sleep

Sip settling drinks such as iced water, ginger or peppermint tea

• Don’t drink milk. Although this gives you an initial cooling sensation, it causes your stomach to produce more acid shortly afterwards

• Avoid antacid preparations, unless recommended by your doctor midwife or chemist. Some contain high levels of aluminum or sodium, which are dangerous for pregnant women.

CRAVINGS AND AVERSIONS

Some women experience cravings for the strangest foods. Usually, they pose role threat to either you or the baby as long as you still manage to consume a well-balanced diet Obviously you should try to make sure that they are not high in refined sugars and fats and don’t pose any food poisoning risk Sometimes particularly strange cravings for coal for example – are a sigma of nutritional deficiency and should be mentioned to your doctor or midwife Mary women also find that they develop a strong aversion to a few flavors during pregnancy. This is again due to hormonal fluctuations.

The most common taste dislikes are coffee, English-style tea and fatty foods. If a food aversion helps you to give up caffeinated drinks, be grateful. For hot drink substitutes.

CONSTIPATION AND PILES

Constipation can occur when extra hormones produced in pregnancy cause the intestine to relax and become less efficient. Over time, it can lead to the development of hemorrhoids (piles), an extremely uncomfortable condition that can cause intense itching and can even bleed, Eating plenty of fruit. vegetables, wholegrain cereals and drinking plenty of water will all help. Light exercise can also help to get the muscles moving.

INSOMNIA

It is often difficult to sleep during the last weeks of pregnancy, when it is difficult to get comfortable and you have a frequent need to urinate, as the baby sits heavily on your bladder How to sleep soundly .

Issues of infertility

Infertility defined twelve months unprotected intercourse without or the to carry pregnancies live birth. Men deemed Infertile when their sperm are unable fertilize the women when they to become pregnant. Around one seven couples have trouble conceiving Infertility has many some of which are affected the food eat. Although some couples will never be able conceive, despite well adjusting their lifestyle to reduce obstacles, many couples feel that analyzing diets is positive step.

In addition, changing your diet for the better part of pre conceptual care Some simple fertility can be ironed out by boosting your nutritional status. For instance, women who have been taking the pill for years may have poor zinc status, boosting your intake of foods over period of few weeks can improve fertility. Men make new sperm every few days, so dietary changes have virtually immediate impact on the quality of sperm.

WEIGHT

The first thing to address is your Excess body weight either partner can decrease the ability to conceive. It lowers libido and can lead decline sperm production men and an interruption in ovulation Being underweight can also affect fertility. In women who have body weight below the ideal the amount of stored energy your body becomes low that periods can be irregular or Men who keep their body fat levels low experience a drop in testosterone levels, causing or Swings in either up or down, can interfere with hormone levels thus your ability to conceive.

Try to reach your ideal weight range maintain it for six to twelve months. This will allow your body achieve balance of hormones that will maximize your chances and of Unfortunately, many of the drugs used to boost fertility as part of assisted pregnancy procedures such as can cause your weight to This mainly due to hormonal changes, which can lead to cravings for sweet food, fluid retention and a general increase in appetite. Although some weight inevitable with many hormone treatments, this should Concern about infertility can also lead you to comfort Keeping tabs on what you are eating by keeping food diary ensure that your body is getting plenty of healthy.

ALCOHOL

drinking adversely affects male and female reproductive tract toxin, more ingested alcohol the in addition too much alcohol can reduce fertility of the hormone prolactin imbalance cause and infertility Both men and women should reduce their alcohol intake to a maximum of 21 units a week for women and 28 units for men. It may be a good idea to go without allocable for a few weeks, 1o give your body a healthy boost.

CAFFEINE

There has been some interesting research regarding the amount of caffeine a woman drinks and her ability to conceive Caffeine, found in tea, coffee and cola-based drinks reduces the blood prolactin level, any imbalance in the level of the hormone prolactin is associated with infertility.

B VITAMINS

Vitamin B12 deficiency, although rare can lead to pernicious anemia, which is associated with infertility. The only way to treat pernicious anemia is to have a course of vitamin B12 injections. Once the vitamin B12 levels return, fertility is restored. Vitamin B6 has been shown in some women to increase levels of progesterone, a female hormone that is needed to maintain a healthy womb lining that can support the growth of a fertilized egg Good sources of vitamin B6 include dairy products, dark green leafy vegetables such as broccoli, nuts and yeast extract. I would not recommend a supplement as an excess of vitamin B6 can cause extreme lethargy and serious liver problems Lack of folic acid has also been linked to infertility.

VITAMIN C

There is some evidence to support the theory that if a man increases his intake of vitamin C it helps to improve his fertility. When sperm enter a woman’s body. antibodies directed against them cause the sperm to clump together (agglutinate). which renders them less likely to fertilize the egg. The presence of vitamin C helps reduce the agglutination process Both men and women should ensure they have good levels of vitamin C in their diet. Fresh vegetables and fruit are the best sources of vitamin C. which is one reason why everyone is recommended to eat at least five helpings of fruit or vegetables every day.

ZINC

One of the key minerals involved in sperm production and male hormone levels is zinc. It has been shown that if a man is low in zinc, both the level of male hormone and the sperm count decrease. Zinc-rich foods include oysters and other seafood, meat and crumbly cheeses such as Lancashire.

DON’T FORGET PROTEIN AND FAT

Low intakes of either protein or fat can impair fertility. For instance, inadequate intakes of the essential fatty acid linoleic acid can lead to infertility. Linoleic acid is found in vegetable oils, nuts and lean meat